深圳市药品集团采购现状及对公立医院药品费用和结构的影响

Group purchasing practice in Shenzhen and its influence on drug cost and structure of public hospitals

目的通过对施行药品集团采购(group purchasing organization,GPO)前后深圳全市及样本公立医院药品采购平台、数量、金额、品种和费用的分析,探讨深圳市GPO及其对公立医院药品结构和费用的影响。方法选取参与GPO的综合医院、专科医院各2家,对GPO平台、广东省第三方药品电子交易平台的药品采购数据和样本医院药品采购、医院收入、均次费用等数据进行描述性分析,并运用Pearson相关分析分析GPO与药占比之间的相关性。结果2018年1—6月,GPO金额占全市公立医院药品采购总金额的62.60%。2017年4家样本医院GPO药品种类占全院药品采购种类的50.00%左右。自GPO启动,深圳市药占比控制在30.00%以下,且缓慢下滑,与药占比呈强负相关(R=-0.884,P<0.05),样本医院药占比、均次费用等有所下降。西药GPO比例略高于中成药,GPO和非GPO平台采购的药品结构各有特点,2017年4家样本医院整体药品采购结构变化不大。结论GPO稳步推进,且对医院药品品种结构影响不大;控费作用显著,医院药品费用和门诊、住院费用降低;有利于降低药占比,提高临床合理用药水平;对综合医院的影响大于专科医院。

Objective To explore the influence of group purchasing organization(GPO)program on drug structure and cost of public hospitals in Shenzhen by analyzing the drug purchasing platform,quantity,amount,variety,and cost of overall and sample public hospitals in Shenzhen before and after GPO.Methods Two general hospitals and two specialized hospitals participating in GPO were selected as study subjects.The drug purchasing data on GPO platform and third-party electronic drug purchasing platform of Guangdong Province,as well as drug purchasing,hospital income,average cost,and other data of sample hospitals were described,and the correlation between GPO and drug proportion was analyzed by Pearson correlation test.Results From January to June of 2018,the purchase amount of GPO accounted for 62.60%of the total drug purchase amount of public hospitals in Shenzhen.In 2017,the GPO purchase amount accounted for about 50.00%of the total drug purchase amount of the four sample hospitals.Since the conduction of GPO program,the drug proportion in Shenzhen was controlled below 30.00%and gradually declined.It had a strong negative correlation(R=-0.884,P<0.05)with the ratio of GPO.The drug proportion and average cost of sample hospitals decreased.The purchase proportion of Western medicine was a little higher than that of Chinese patent medicine.The structures of drugs purchased on GPO and non-GPO platforms were different.In 2017,the overall drug procurement structure of the four sample hospitals changed little.Conclusion GPO program has been advancing steadily with little impacts on hospital drug variety structure.It plays a significant role in controlling drug costs and outpatient and inpatient costs,and reducing the proportion of drugs to improve rational drug use.The impacts on general hospitals are greater than those on specialized hospitals.